When patients lack capacity to decide whether to undergo medical treatment, the Court of Protection is often called upon to decide what is in their best interests. Recently, the Court ruled that it was in the best interests of a young man to undergo surgery to correct the curvature of his spine.

The 18-year-old man suffered from progressive scoliosis and a number of other conditions. He had complex learning disabilities and his communication was limited. It was clear that he lacked capacity to make a decision about his medical treatment.

His scoliosis had worsened in recent years and surgical correction of the curvature of his spine was proposed. Due to his disabilities, he would not be able to cope with the pain and immobility he would experience in the post-operative period, and would be likely to tear off dressings and pull out monitoring devices and lines delivering drugs. It was agreed that the only option for post-operative care would be to heavily sedate him and to maintain mechanical ventilation for a period of probably two to three weeks. Those involved considered the decision to be finely balanced, and an application to the Court of Protection was therefore made.

The Court considered medical evidence that, as well as the risks of the surgery, there were risks attached to the planned post-operative care. The Court estimated that there was a 10 per cent risk of death and a 30-40 per cent chance of complications requiring a significant increase in the time spent in intensive care and/or on mechanical ventilation. However, successful surgery would increase his life expectancy by 5-10 years.

The man’s mother told the Court that he was an active young man and full of life, although he now found it difficult to maintain the same position for more than five minutes without discomfort, could not sit comfortably or upright in a chair and seemed to get out of breath more easily. He particularly loved spending time with his family. Having listened to the medical professionals’ evidence, she thought it was in his best interests to proceed with the surgery.

The Court noted that the case involved a stark choice. There was no conservative treatment that would help the man’s scoliosis, and no safe way of offering him surgery without the post-operative intensive care. Either he had the corrective surgery and post-operative care or he had no treatment at all. A successful outcome would reduce his scoliosis by 50 per cent, improving his mobility and stopping his progressive scoliosis. The surgery was more likely than not to be successful and to achieve significant benefits for him. Without surgery, his scoliosis could well worsen and his lung function would deteriorate further, and he would be unlikely to live to the age of 30.

The man clearly enjoyed life and the Court believed he would want to continue living and enjoying the love and company of his family for as long as he could, provided he was not in too much pain or distress. A successful operation would give that to him. The Court concluded that it was in his best interests to undergo the proposed surgery and post-operative care.